In the Spin II: You and Your Billing Code
Pass the Valium!
Previously on e-Patients.net I recounted the crazy-making quest for a second opinion on an abnormal mammogram (microcalicifications) as per the advice of New York Times health columnist and breast cancer survivor Jane E. Brody. The gynecologist who ordered the mammogram refused to authorize a second opinion, however, deferring to the radiologist, who referred me back to the clinic and so on and so forth.
My primary care provider, who carefully reviewed the films and reports (sans compensation), thought a biopsy might be the safe thing. She was not the referring entity, however. The clinic was !#$^%$#@
I started over, skipping a few bases, securing a first-rate surgeon at the county hospital as the new referral entity. In a futile attempt to waste no one’s time except my own, I hand-carried a disc of the imaging studies to the appointment.
Right?
Wrong!
Read more
NIH Summit on Health Disparities
NIH is sponsoring a summit this week, The Science of Eliminating Health Disparities. I heard about it from Mary Brophy Marcus’s article in USA Today and I found this press release online, but I haven’t seen other coverage of the event. If you spot stories about the summit in the news, on blogs, on Twitter, etc., please post links in the comments.
The summit program is a treasure trove of ideas for conference organizers who want to answer Gilles Frydman’s call to action.
“I can buy a damn good amputation…”
Paul Grundy MD, of IBM, chair of PCPCC, is interviewed in the current Crain’s Benefits Outlook, a business publication about employee benefit programs. This quote alone is worth the price of admission:
I can buy a damn good amputation for my diabetic, but what I can’t get is a good system in place to prevent my diabetic from needing the amputation. We don’t reward a system in which comprehensive coordinated care and robust prevention is valued.
Amen. What are we thinking, insurers, when we fund treatments instead of preventing them??
“The Evidence Gap”: Pharma impedes patient access to better treatment
A lot of effort and study is going into improving healthcare and untangling its cost structure. So methinks it’s nearly criminal when someone blocks adoption of a treatment that’s better, especially when it’s also less expensive.
Case in point, from yesterday’s NY Times: The Evidence Gap: The Minimal Impact of a Big Hypertension Study
The surprising news made headlines in December 2002. Generic pills for high blood pressure, which had been in use since the 1950s and cost only pennies a day, worked better than newer drugs that were up to 20 times as expensive.
The findings, from one of the biggest clinical trials ever organized by the federal government, promised to save the nation billions of dollars in treating the tens of millions of Americans with hypertension.
Six years later, though, the use of [diuretics] is far smaller than some of the trial’s organizers had hoped.
What?? I use diuretics, prescribed by my e-patient doc, Danny Sands. Doesn’t every BP patient? They reduce water content in the body, lowering blood pressure. Why isn’t every BP patient doing this?
No *other* conflict of interest, huh?
What’s wrong with this picture?
While continuing to search for information regarding the collective statistical illiteracy issue covered a couple of days ago, I found a brand new article in the New England Journal of Medicine.
As an exercise I decided to reorganize some of the paragraphs of the article, bringing to the top a couple of paragraphs that are located at the bottom of the original. FYI, the conclusion of the article is simple: “In this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin (Note by G.F: Crestor, manufactured by AstraZeneca) significantly reduced the incidence of major cardiovascular events. ” Surprise, surprise! Crestor is good for you, even if you don’t have high cholesterol levels. Read the rest, it may explain:
Your Health Information at Your Fingertips
Nancy B. Finn is a journalist with an expertise in the implementation of digital communications in health care and shared this story about personal health records:
I was recently hospitalized. Fortunately I did not have to go through the emergency department but was admitted directly to a room. When I arrived, the nurse assigned to my case sat down with me to go over my medical history and medications. Much to her surprise I provided her with my personal health record (PHR) that I had created several months earlier on the iHealth Record web site www.ihealthrecord.org. My PHR included information on the illnesses I had contracted; my family medical history, medical proxy, and most important my medications and allergies to medications and food. With this information, the nurse was able to complete our interview quickly and efficiently, confident that the information was accurate and up to date. She let me know that she had not run into a patient with a PHR before and that she was clearly impressed.
Information Silos Are Everywhere. But So Is The Internet!
Information Silo: An information silo is a management system incapable of reciprocal operation with other, related management systems… “Information silo” is a pejorative expression that is useful for describing the absence of operational reciprocity. Derived variants are “silo thinking”, “silo vision”, and “silo mentality”. (from Wikipedia)
Although much has been written about them, information silos are becoming far more recognized as the major reason why organizations are unable to take full advantage of the Internet’s power to interconnect business processes.
One of the great presentations at the Connected Health Symposium was “Illness in the Age of “e”: A Case Study in Participatory e-Medicine”, a conversation between e-Patient Dave deBronkart and his PCP, Danny Sands, M.D., MPH, who shares his time between a general internist practice at Beth Israel Deaconess Medical Center (one of the Harvard teaching hospitals), and serving as the Senior Medical Informatics Director at Cisco Systems. Danny is also an early proponent of patient empowerment and one of the authors of the e-Patients White Paper.
Health 2.0 & The Widening Digital Divide: A Call to Action
Too many years witnessing the same thing. First in the ACOR system. Then in many conferences about eHealth, e-Patients and now Health 2.0 and the Connected Health symposium at Harvard Medical School. Why is an entire segment of the US population almost completely absent from the fast evolving world of Health 2.0 and Participatory Medicine?
Wall Street Journal goes e-Patient
Where have we heard this story before?
A friend of mine slipped on the sidewalk recently and broke her hip. She had surgery in one of the best hospitals in the country.
But it [wasn't their staff, it] was her grown daughter who noticed that she was having an adverse reaction to a pain medication. And that her IV drip had pulled out of a vein and was pumping her arm full of fluid. And that the hot compresses to reduce the swelling in her arm had left blisters on her skin. And that the blood-sugar test she was about to be given was meant for her roommate instead.
How can we have informed patients, if hospitals won’t inform?
This post is prompted by a horrid subject: how do we as a society deal with one of the worst possible events – a death in our healthcare system?
The immediate topic is a 37 year old woman who died last week at Beth Israel Deaconess Medical Center (BIDMC). An article in today’s Boston Globe discusses the hospital’s policy of openness about everything, even including tragedies. I think this policy is vitally important, though potentially very risky, and I want to say why I believe it’s so important.
The question that will make a difference is: What policies, what problem-solving approach, can possibly pull the American health care system out of the tangled, knotted, entrenched mess that it’s become?
white paper
e-Patients:
How They Can Help Us Heal Healthcare
